关节镜下有限清理术治疗膝关节骨性关节炎临床效果及影响因素分析
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摘要
目的探讨关节镜下有限清理术治疗膝关节骨性关节炎(knee osteoarthritis,KOA)临床效果及影响因素。方法选取关节镜下有限清理术治疗KOA 108例,分析性别、年龄及疾病情况等一般资料,以及临床治疗效果和膝关节疼痛、膝关节功能及Kelgren Lawrence分级等相关资料,并分析影响关节镜下有限清理术治疗KOA患者效果的相关因素。结果出院后3个月,KOA 108例中优28例,良44例,中26例,差10例,优良率为66. 67%,中差率为33. 33%。KOA 108例关节镜下有限清理术治疗后视觉模拟评分法(VAS)评分和Kellgren Lawrence分级显著降低,而Lysholm膝关节功能评分明显提高,差异均具有统计学意义(P <0. 05)。非条件单因素分析结果显示,术前不同VAS评分、Lysholm膝关节功能评分、Kellgren Lawrence分级及不同年龄、不同心理期望康复值、术后是否严格遵守并坚持锻炼与KOA患者关节镜下有限清理术治疗效果有关系。多因素Logistic回归分析结果显示,术前高VAS评分、低Lysholm膝关节功能评分、高Kellgren Lawrence分级及年龄≥60岁、高心理期望康复值均为影响KOA患者关节镜下有限清理术治疗效果的独立危险因素。结论关节镜下有限清理术治疗KOA有较好效果,但术前高VAS评分、低Lysholm膝关节功能评分、高Kellgren Lawrence分级及年龄≥60岁、高心理期望康复值为影响KOA患者关节镜下有限清理术治疗效果的独立危险因素。
Objective To investigate the clinical effect of limited debridement under arthroscopy in the treatment of knee osteoarthritis( KOA) and to analyze the related factors affecting the therapeutic effect. Methods A total of 108 patients with KOA treated by limited debridement under arthroscope were selected as the research subjects. The general data of gender,age and disease were analyzed. The clinical therapeutic effect,knee pain,knee joint function and Kelgren Lawrence grade before and after treatment were also analyzed. Related factors influencing the outcome of KOA patients treated with limited debridement were analyzed. Results Three months after discharge,for 108 cases of KOA,the results were excellent in 28 cases,good in 44 cases,fair in 26 cases and poor in10 cases. The excellent and good rate was 66. 67%,and the fair and poor rate was 33. 33%. The visual analogue scale( VAS) score and Kellgren Lawrence grade of 108 KOA patients were significantly decreased after limited debridement under arthroscopy,while the Lysholm knee function score was significantly improved,suggesting significant differeces( P < 0. 05). The results of unconditional single-factor logistic regression model analysis showed that different VAS scores,Lysholm knee function scores,and Kellgren Lawrence grades before surgery,in addition to different ages,different psychological expectations of rehabilitation,and strict compliance with and adherence to exercise after surgery were related to the therapeutic effect of limited debridement under arthroscopy in KOA patients.Multivariate logistic regression analysis showed that preoperative high VAS score,low Lysholm knee function score,high Kellgren Lawrence grade,age of 60 and over,and high psychological expectation were independent risk factors affecting the therapeutic effect of limited debridement under arthroscopy in KOA patients. Conclusion Limited debridement under arthroscopy has a good clinical effect in the treatment of KOA,however,preoperative high VAS score,low Lysholm knee function score,high Kellgren Lawrence grade,age of 60 and over,and high psychological expectation are independent risk factors affecting the therapeutic effect of limited debridement in KOA patients.
Objective To investigate the clinical effect of limited debridement under arthroscopy in the treatment of knee osteoarthritis( KOA) and to analyze the related factors affecting the therapeutic effect. Methods A total of 108 patients with KOA treated by limited debridement under arthroscope were selected as the research subjects. The general data of gender,age and disease were analyzed. The clinical therapeutic effect,knee pain,knee joint function and Kelgren Lawrence grade before and after treatment were also analyzed. Related factors influencing the outcome of KOA patients treated with limited debridement were analyzed. Results Three months after discharge,for 108 cases of KOA,the results were excellent in 28 cases,good in 44 cases,fair in 26 cases and poor in10 cases. The excellent and good rate was 66. 67%,and the fair and poor rate was 33. 33%. The visual analogue scale( VAS) score and Kellgren Lawrence grade of 108 KOA patients were significantly decreased after limited debridement under arthroscopy,while the Lysholm knee function score was significantly improved,suggesting significant differeces( P < 0. 05). The results of unconditional single-factor logistic regression model analysis showed that different VAS scores,Lysholm knee function scores,and Kellgren Lawrence grades before surgery,in addition to different ages,different psychological expectations of rehabilitation,and strict compliance with and adherence to exercise after surgery were related to the therapeutic effect of limited debridement under arthroscopy in KOA patients.Multivariate logistic regression analysis showed that preoperative high VAS score,low Lysholm knee function score,high Kellgren Lawrence grade,age of 60 and over,and high psychological expectation were independent risk factors affecting the therapeutic effect of limited debridement under arthroscopy in KOA patients. Conclusion Limited debridement under arthroscopy has a good clinical effect in the treatment of KOA,however,preoperative high VAS score,low Lysholm knee function score,high Kellgren Lawrence grade,age of 60 and over,and high psychological expectation are independent risk factors affecting the therapeutic effect of limited debridement in KOA patients.
引文
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[10]王纯育,钟晓,罗健.膝关节镜清理术联合去神经化治疗膝骨性关节炎的临床疗效[J].中国中医骨伤科杂志,2016,24(10):32-34.
[11]赵飞,张剑刚,李存祥,等.腓骨截骨与关节镜下清理术治疗膝骨关节炎伴轻度膝内翻疗效分析[J].实用骨科杂志,2016,22(9):852-855.
[12]汤继磊,沈向阳,高为人,等.关节镜下关节清理术治疗合并半月板损伤的膝骨关节炎24例[J].江苏医药,2016,42(2):213-214.
[13]酒涛,李彦周,程伟,等.关节镜清理配合腓骨截骨术治疗膝骨性关节炎41例的疗效观察[J].中国中医骨伤科杂志,2016,23(8):60-62.
[14]全海祥,康一凡,沈国华,等.关节镜下微骨折术和关节清理术修复膝关节软骨缺失临床疗效对比研究[J].中国骨与关节损伤杂志,2016,31(10):1088-1089.
[15] Wu Z,Chen S,Li Y,et al. Effect of centre-edge angle on clinical and quality of life outcomes after arthroscopic acetabular labral debridement[J]. Int Orthop,2015,40(7):1427-1432.
[16]申晓坤,李发祥,王维山,等.关节镜治疗膝骨关节炎疗效影响因素的回归分析[J].局解手术学杂志,2016,25(8):585-588.
[17]解骏,翟伟韬,肖涟波,等.老年膝关节骨性关节炎关节镜下不同清理程度的临床疗效和关节功能恢复比较[J].疑难病杂志,2016,15(3):292-294,302.
[18]唐炼,陈洁盈,鲁晓波.活血通络凝胶联合关节镜下关节清理术治疗膝关节骨性关节炎临床效果观察[J].中华中医药学刊,2016,34(10):2510-2513.
[19]吐尔洪·吐尔逊,陈洪涛.关节镜下有限清理术联合中药烫疗治疗老年膝关节骨性关节炎疗效观察[J].现代中西医结合杂志,2017,26(22):2490-2492.
[20]白晓军.关节镜辅助下微创内固定治疗对胫骨平台骨折患者膝关节功能的影响[J].现代仪器与医疗,2015,21(5):40-42.
[21]郝亮,简蔚泓,杨锋,等.腓骨近端截骨联合膝关节镜清理术治疗伴内翻畸形的膝关节骨关节炎[J].中国修复重建外科杂志,2016,30(11):1366-1369.
[22]李萌,贾叙锋,周玉,等.膝关节镜清理术联合中药离子导入治疗膝骨性关节炎的临床研究[J].中国中医骨伤科杂志,2017,21(3):25-28.
[23]陈小光,陈阳.膝关节骨性关节炎伴半月板损伤的关节镜治疗分析[J].现代仪器与医疗,2018,24(3):75-77.
[24]吴启平,梁炳生.膝骨关节炎患者关节镜下选择性清除术的疗效观察[J].山西医药杂志,2017,46(10):1208-1210.
[25] van Eekeren I C,van Bergen C J,Sierevelt I N,et al. Return to sports after arthroscopic debridement and bone marrow stimulation of osteochondral talar defects:a 5-to 24-year follow-up study[J]. Knee Surg Sports Traumatol Arthrosc,2016,24(4):1311-1315.
[26]李磊.关节镜有限清理术联合补肾壮骨汤治疗膝骨性关节炎疗效及对NO、IL-1β、TGF-β1水平的影响[J].现代中西医结合杂志,2017,26(19):2081-2083,2087.
[27]闫治中,李方琨,张希军,等.关节镜下清理术结合散瘀通络汤内服治疗膝骨关节炎的疗效分析[J].腹腔镜外科杂志,2017,22(5):386-388.
[2]樊勤学,陈玉明.玻璃酸钠关节腔内注射联合氨基葡萄糖治疗膝关节骨性关节炎的效果观察[J].中国医药,2014,9(4):529-531.
[3]野战涛,张卫平.膝关节骨性关节炎的治疗进展[J].临床误诊误治,2010,23(8):783-786.
[4]尤传飞,邱维胜,徐雷军,等.关节镜下关节清理术治疗膝骨性关节炎的临床效果及影响因素[J].中外医疗,2017,36(26):74-76.
[5]姜丽,张金华.臭氧联合玻璃酸钠治疗膝关节骨性关节炎的临床研究[J].中国临床医生杂志,2016,44(6):67-68.
[6]王志忠,胡叶暖,刘献旺.骨龙胶囊联合盐酸氨基葡萄糖片治疗膝关节骨性关节炎的临床效果分析[J].中国医药,2015,10(12):1808-1810.
[7]王立新,杜向阳.关节镜下关节清理扩创微骨折术后配合运动疗法治疗中老年膝骨关节炎[J].临床军医杂志,2016,44(7):761-763.
[8]徐昕,董耘,徐华,等.关节镜清理术联合透明质酸钠腔内注射治疗80例高龄膝关节骨性关节炎患者临床分析[J].中华全科医学,2016,14(9):1463-1465.
[9]张达义,张媛,佟宇.膝关节骨性关节炎的六维诊疗模式疗效分析[J].中国煤炭工业医学杂志,2016,18(8):1211-1213.
[10]王纯育,钟晓,罗健.膝关节镜清理术联合去神经化治疗膝骨性关节炎的临床疗效[J].中国中医骨伤科杂志,2016,24(10):32-34.
[11]赵飞,张剑刚,李存祥,等.腓骨截骨与关节镜下清理术治疗膝骨关节炎伴轻度膝内翻疗效分析[J].实用骨科杂志,2016,22(9):852-855.
[12]汤继磊,沈向阳,高为人,等.关节镜下关节清理术治疗合并半月板损伤的膝骨关节炎24例[J].江苏医药,2016,42(2):213-214.
[13]酒涛,李彦周,程伟,等.关节镜清理配合腓骨截骨术治疗膝骨性关节炎41例的疗效观察[J].中国中医骨伤科杂志,2016,23(8):60-62.
[14]全海祥,康一凡,沈国华,等.关节镜下微骨折术和关节清理术修复膝关节软骨缺失临床疗效对比研究[J].中国骨与关节损伤杂志,2016,31(10):1088-1089.
[15] Wu Z,Chen S,Li Y,et al. Effect of centre-edge angle on clinical and quality of life outcomes after arthroscopic acetabular labral debridement[J]. Int Orthop,2015,40(7):1427-1432.
[16]申晓坤,李发祥,王维山,等.关节镜治疗膝骨关节炎疗效影响因素的回归分析[J].局解手术学杂志,2016,25(8):585-588.
[17]解骏,翟伟韬,肖涟波,等.老年膝关节骨性关节炎关节镜下不同清理程度的临床疗效和关节功能恢复比较[J].疑难病杂志,2016,15(3):292-294,302.
[18]唐炼,陈洁盈,鲁晓波.活血通络凝胶联合关节镜下关节清理术治疗膝关节骨性关节炎临床效果观察[J].中华中医药学刊,2016,34(10):2510-2513.
[19]吐尔洪·吐尔逊,陈洪涛.关节镜下有限清理术联合中药烫疗治疗老年膝关节骨性关节炎疗效观察[J].现代中西医结合杂志,2017,26(22):2490-2492.
[20]白晓军.关节镜辅助下微创内固定治疗对胫骨平台骨折患者膝关节功能的影响[J].现代仪器与医疗,2015,21(5):40-42.
[21]郝亮,简蔚泓,杨锋,等.腓骨近端截骨联合膝关节镜清理术治疗伴内翻畸形的膝关节骨关节炎[J].中国修复重建外科杂志,2016,30(11):1366-1369.
[22]李萌,贾叙锋,周玉,等.膝关节镜清理术联合中药离子导入治疗膝骨性关节炎的临床研究[J].中国中医骨伤科杂志,2017,21(3):25-28.
[23]陈小光,陈阳.膝关节骨性关节炎伴半月板损伤的关节镜治疗分析[J].现代仪器与医疗,2018,24(3):75-77.
[24]吴启平,梁炳生.膝骨关节炎患者关节镜下选择性清除术的疗效观察[J].山西医药杂志,2017,46(10):1208-1210.
[25] van Eekeren I C,van Bergen C J,Sierevelt I N,et al. Return to sports after arthroscopic debridement and bone marrow stimulation of osteochondral talar defects:a 5-to 24-year follow-up study[J]. Knee Surg Sports Traumatol Arthrosc,2016,24(4):1311-1315.
[26]李磊.关节镜有限清理术联合补肾壮骨汤治疗膝骨性关节炎疗效及对NO、IL-1β、TGF-β1水平的影响[J].现代中西医结合杂志,2017,26(19):2081-2083,2087.
[27]闫治中,李方琨,张希军,等.关节镜下清理术结合散瘀通络汤内服治疗膝骨关节炎的疗效分析[J].腹腔镜外科杂志,2017,22(5):386-388.